Updated Perinatal Guidelines

Updated Perinatal Guidelines

New recommendation on use of antiretroviral therapy (ART) for serodiscordant couples who want to conceive, with strength of the recommendation differing on the basis of the infected partner’s CD4-cell count.

Added discussion of the pre-exposure prophylaxis (PrEP) studies in heterosexual couples, with a new recommendation regarding PrEP in discordant couples who want to conceive.

Added discussion on benefit of therapy for reducing sexual transmission to discordant partners when viral suppression is maintained.

Reclassification of various antiretroviral (ARV) agents to the categories of Preferred Agents, Alternative Agents, or for Use in Special Circumstances.

Increased discussion on timing (that is, trimester) of initiation of ARV drugs in ARV-naive pregnant women. Discussion of continuation of efavirenz in women receiving efavirenz-based ART who present for antenatal care in the first trimester.

Addition of a new table: Table 7 – Results of Studies Assessing Association Between Antiretroviral Regimens and Preterm Delivery.

Discussion of use of intravenous (IV) zidovudine during labor and maternal viral load, with recommendation that IV zidovudine is needed only for women with HIV RNA ≥400 copies/mL (or unknown HIV RNA) near delivery.

Updated information and discussion concerning infant ARV prophylaxis in the context of the NICHD-HPTN 040 study.

New recommendations regarding postnatal care of the HIV-exposed neonate.